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Gas-to-liquid (GTL) technology involves the conversion of natural gas into several liquid hydrocarbon products. The Fischer–Tropsch (F–T) process is the most widely applied approach for GTL, and it is the main source of wastewater in the GTL process. The wastewater is generally characterized by high chemical oxygen demand (COD) and total organic carbon (TOC) content due to the presence of alcohol, ketones and organic acids. The discharge of this highly contaminated wastewater without prior treatment can cause adverse effects on human life and aquatic systems. This review examines aerobic and anaerobic biological treatment methods that have been shown to reduce the concentration of COD and organic compounds in wastewater. Advanced biological treatment methods, such as cell immobilization and application of nanotechnology are also evaluated. The removal of alcohol and volatile fatty acids (VFA) from GTL wastewater can be achieved successfully under anaerobic conditions. However, the combination of anaerobic systems with aerobic biodegradation processes or chemical treatment processes can be a viable technology for the treatment of highly contaminated GTL wastewater with high COD concentration. The ultimate goal is to have treated wastewater that has good enough quality to be reused in the GTL process, which could lead to cost reduction and environmental benefits.